Carolinas HealthCare System

New Ultrasound Technique Improves Endometriosis Detection and Treatment

Kevin Stepp, MD

Kevin Stepp, MD
Director of Advanced Surgical
Specialties for Women

Physicians at Carolinas HealthCare System's Women's Center for Pelvic Health (WCPH), a facility of Carolinas Medical Center-Mercy, are now offering an extremely effective and unique ultrasound procedure to help women with endometriosis. The WCPH is among the first facilities in the United States with physicians who are trained to perform this technique.

Kevin Stepp, MD, director of advanced surgical specialties for women, and Elizabeth Morgan, MD, FACOG, recently completed their training in Sao Paulo, Brazil. There, they worked under the direction of Mauricio Abrao, MD, and his team of radiologists who developed the focused ultrasound technique for endometriosis. "I anticipate that over 90 percent of my endometriosis surgeries and most of Dr. Morgan's new patients would benefit from this ultrasound technique. It will help identify patients who may benefit from surgery versus those who may be able to be managed by their referring gynecologist or other specialist," Dr. Stepp said. "This helps both the referring gynecologist and the patient."

Benefits of the new ultrasound technique include:

  • Endometriosis is an extremely difficult disease to both diagnose and to treat.
    • Symptoms often do not correlate with presence or severity of disease.
    • Physical exam is often inaccurate and MRI is typically not helpful.
  • Diagnosis of endometriosis must be made by obtaining tissue at the time of laparoscopic surgery.
    • Invasive surgery is necessary to definitively diagnose a patient with endometriosis.
  • Many patients' initial surgery results in incomplete treatment of their disease.
    • The lack of ability to predict deep invasive disease interferes with the gynecologist's ability to determine which patients may need to be referred to an advanced multi-disciplinary surgical team capable of removing invasive lesions.
  • Recurrence of endometriosis with pain and infertility is common after incomplete surgery.
    • It is difficult to treat these patients and to determine who may benefit from further surgery.
    • Repeat surgeries for symptoms are not only cost-prohibitive but may result in new pain and scar tissue.
  • Recently, the American Institute of Ultrasound in Medicine recommended a task force to evaluate the use of ultrasound in the evaluation of pelvic pain.
    • The task force demonstrated that pelvic ultrasound is superior to other imaging modalities when evaluating disease and pain in the female pelvis.

Carolinas HealthCare System's goal is to provide continuing education offerings to radiologists within the organization so that they can also treat patients using the new procedure.

"We are on track to be one of the largest imaging centers for endometriosis in the United States, a place where we offer updated, complete sonographic evaluation of this condition. The service, launched in August, will allow our team to assist with both surgical and nonsurgical management," Dr. Morgan said.

Dr. Stepp, along with Michael Kennelly, MD, FACS, and Bernard Taylor, MD, FACOG, all from Carolinas HealthCare System, are among the first physicians in the world to become board-certified urogynecologists, specializing in female pelvic medicine and reconstructive surgery, as recognized by the American Board of Medical Specialties.

Female pelvic medicine and reconstructive surgery is a subspecialty of obstetrics and gynecology and urology that treats urogynecological conditions such as incontinence and pelvic prolapse. This subspecialty just obtained approval to offer board certification from the American Board of Medical Specialties in 2012. And in June 2013, Drs. Stepp, Kennelly and Taylor successfully passed the national exam the first time it was offered.

The Women's Center for Pelvic Health also works in close collaboration with the reproductive medicine and infertility team at Carolinas HealthCare System's Reproductive Medicine and Infertility, a new top-of-the-line facility at CMC-Women's Institute, which opened in October.

More Information about the New Reproductive Medicine and Infertility Facility and Team

Mr. Piemont joins the reproductive medicine and infertility team at Carolinas HealthCare System’s Reproductive and Infertility, as they cut the ribbon to celebrate the official opening of the brand new facility.

The recently opened reproductive medicine and infertility facility provides expanded space and more capabilities than before, allowing a team of physicians to lead the future of reproductive medicine.

The team comprises of Paul Marshburn, MD; Bradley Hurst, MD; Michelle Matthews, MD; and Rebecca Usadi, MD. They are able to see patients more quickly in a private, comfortable environment and perform more procedures due to the new facility, which is several times larger than what they had to work in before.

Additionally, one of the factors that leads to a higher success rate in reproductive medicine is the ability to transfer just one embryo as opposed to multiple. This facility allows for a more advanced use of genetic testing, which helps the specialists identify which embryos will make healthier babies and cut down on the need to implant multiple embryos.

"It's great to know that our administration has confidence in us; this is validation that what we do is valued," said Dr. Hurst, director of the assisted reproduction program. "Currently, one percent of all babies born in the United States are born by in vitro fertilization (IVF.) This proves that this process is working and there is a demand for it. With our new facility in place, we can continue to provide quality patient care and provide successful outcomes for families."

The physical construction of the facility was finalized in August. However, the space remained empty for several months until the "burn-in" phase was complete. This phase was a process to improve air quality and regulate the environment at an optimal level essential for embryo development. The air filtration system in the new facility is extremely complex: Any air that enters the lab must be extremely pure and be removed of all organic solvents.

The ventilation system was just one of many intricate details that were a part of the design and construction plan for the facility. Prior to its creation, an environmental consultant carefully scrutinized potentially toxic materials in the space that could be found in flooring, paint, curtains, cabinets and lighting. These elements were investigated to help ensure that the developing embryos would not be harmed from outside elements potentially found in these materials.

The facility is currently one of the only reproductive centers in Charlotte. It's home to board-certified reproductive endocrinologists, who are nationally recognized academic and research leaders. Further, it's the only comprehensive regional provider of advanced reproductive preservation for cancer patients.

Team Specialties

  • Paul Marshburn, MD: assisted reproductive technology, endometriosis, male factor infertility, polycystic ovary syndrome, and advanced laparoscopy and microsurgery
  • Bradley Hurst, MD: IVF, infertility and minimally invasive surgeries including fibroid surgery and Fertiloscopy, a new surgery to diagnose and treat infertility
  • Michelle Matthews, MD: polycystic ovarian syndrome, IVF and fertility preservation for cancer patients
  • Rebecca Usadi, MD: fertility, advanced laparoscopy and hysteroscopy, polycystic ovary syndrome, preconception genetic screening, and the effect of weight on fertility

The physicians at Carolinas HealthCare System's Reproductive Medicine and Infertility have over 50 years of combined experience and are pioneers in the field of reproductive medicine.

Learn more about Carolinas HealthCare System's Reproductive Medicine and Infertility.